A case is described in which a man with asthma and a history of alcohol dependence presented with a paranoid psychosis refractory to standard neuroleptic treatment. Symptomatic improvement was achieved when abuse of salbutamol (Ventolin®) metered dose inhaler was discovered and an alternative β2-agonist delivery system prescribed. A contribution by salbutamol to the psychosis is proposed. It is suggested that increased awareness regarding psychiatric morbidity is needed when metered dose salbutamol inhalers are prescribed.
